Justina Sullivan Pham, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

48855 Issued in CA

Practice address

2780 State Street
Suite 12
Santa Barbara, CA 93105

Phone

(805) 687-1411

Fax

(805) 687-1429

NPI assigned

Oct 1, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Justina Melissa Sullivan Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Dec 14, 2015 through Dec 14, 2027

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1191196800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1375228800000",
    "number": "1386831550",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2780 STATE STREET",
            "address_2": "SUITE 12",
            "city": "SANTA BARBARA",
            "state": "CA",
            "postal_code": "93105",
            "telephone_number": "805-687-1411",
            "fax_number": "805-687-1429"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2780 STATE STREET",
            "address_2": "SUITE 12",
            "city": "SANTA BARBARA",
            "state": "CA",
            "postal_code": "93105",
            "telephone_number": "805-687-1411",
            "fax_number": "805-687-1429"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHAM",
        "first_name": "JUSTINA",
        "middle_name": "SULLIVAN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-10-01",
        "last_updated": "2013-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "48855",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "48855",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JUSTINA",
            "last_name": "SULLIVAN",
            "middle_name": "MELISSA",
            "credential": "DDS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kathleen Pritchard Phalen
• Shawn Elizabeth Phalen
• Pham Acupuncture Professional Corporattion (Santa Barbara Herb Clinic)
• Christine Pham
• Dan A Pham, M.D.
• Mina Quynh Pham
• Sonal Vasant Phatak, M.D.
• Dennis B Phelps, M.D.
• Elizabeth Ngoc-Phu Phi, PA-C
• Elizabeth Ann Phifer, PMHNP-BC

• General Practice Dentistry in Santa Barbara, CA
• Providers in Santa Barbara, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.